Provider Demographics
NPI:1104087642
Name:SMITH, TRACY F (MS CCCSLP)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:F
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1386 OLD FREEPORT ROAD
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:PITTSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15238
Mailing Address - Country:US
Mailing Address - Phone:888-734-2202
Mailing Address - Fax:888-293-6854
Practice Address - Street 1:600 SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821
Practice Address - Country:US
Practice Address - Phone:570-275-6100
Practice Address - Fax:570-275-7267
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007112235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist